不同剂量西地那非治疗新生儿持续性肺动脉高压的疗效及安全性分析
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摘要
目的探究不同剂量西地那非治疗新生儿持续性肺动脉高压(PPHN)的疗效。方法按照随机数字表法将78例PPHN患儿分为三组,每组26例。三组患儿均给予西地那非治疗,给药浓度分别为每次0.5mg/kg(低剂量组)、1.0mg/kg(中剂量组)、1.5 mg/kg(高剂量组),每6 h给药1次,记录三组患儿用药前及用药后3 d肺动脉压力(PAP)、动脉氧分压(PO_2)、动脉血二氧化碳分压(PCO_2)、动脉血氧饱和度(SaO_2)、动脉血压及血清内皮素-1(ET-1)、一氧化氮(NO)情况,评价治疗效果及安全性。结果各组患儿治疗后PAP值较治疗前均显著降低(P<0.05),中剂量组及高剂量组患儿PAP值降低幅度显著大于低剂量组(P<0.05);低、中、高剂量组患儿治疗有效率分别为73.08%、88.46%、92.30%;组间比较差异无统计学意义(P>0.05);与治疗前比较,三组患儿治疗后PO_2、SaO_2及血清NO水平均显著升高(P<0.05),PCO_2、ET-1降低(P<0.05),其中中、高剂量组患儿各指标升高或降低幅度显著大于低剂量组,差异有统计学意义(P<0.05);三组患儿动脉血压变化及不良反应发生率差异均无统计学意义(P>0.05)。结论西地那非治疗PPHN治疗效果好,不良反应少,给药浓度为1.0、1.5mg/kg效果较好。
Objective To investigate the efficacy of different doses of sildenafil in the treatment of neonatal persistent pulmonary hypertension(PPHN).Methods Seventy-eight children with PPHN were randomly divided into three groups,26 cases in each group.Sildenafil was administered to all the three groups at a dose of 0.5 mg/kg(low dose group),1.0 mg/kg(medium dose group) and 1.5 mg/kg(high dose group) once every 6 hours.Pulmonary arterial pressure(PAP),arterial partial pressure of oxygen(PO_2),arterial partial pressure of carbon dioxide(PCO_2),arterial oxygen saturation(SaO_2) and arterial blood were recorded before and 3 days after treatment.Blood pressure,serum endothelin-1(ET-1) and nitric oxide(NO) were measured to evaluate the efficacy and safety of the treatment.Results After treatment,the PAP values of the children in each group were significantly lower than those before treatment(P<0.05).The PAP values of children in middle-dose group and high-dose group were significantly lower than those in low-dose group(P<0.05).The effective rates of children in low,medium and high-dose group were 73.08%,88.46% and 92.30% respectively.There was no significant difference between the three groups(P>0.05).The levels of serum NO and PCO_2 and SaO_2 increased significantly(P<0.05),and PCO_2 and ET-1 decreased(P<0.05).The increase or decrease of each index in middle and high dose group was significantly greater than that in low dose group(P<0.05).There was no significant difference in the changes of arterial blood pressure and the incidence of adverse reactions among the three groups(P>0.05).Conclusion Sildenafil is effective in the treatment of PPHN with less adverse reactions.The concentration of sildenafil is 1.0 and 1.5 mg/kg.
Objective To investigate the efficacy of different doses of sildenafil in the treatment of neonatal persistent pulmonary hypertension(PPHN).Methods Seventy-eight children with PPHN were randomly divided into three groups,26 cases in each group.Sildenafil was administered to all the three groups at a dose of 0.5 mg/kg(low dose group),1.0 mg/kg(medium dose group) and 1.5 mg/kg(high dose group) once every 6 hours.Pulmonary arterial pressure(PAP),arterial partial pressure of oxygen(PO_2),arterial partial pressure of carbon dioxide(PCO_2),arterial oxygen saturation(SaO_2) and arterial blood were recorded before and 3 days after treatment.Blood pressure,serum endothelin-1(ET-1) and nitric oxide(NO) were measured to evaluate the efficacy and safety of the treatment.Results After treatment,the PAP values of the children in each group were significantly lower than those before treatment(P<0.05).The PAP values of children in middle-dose group and high-dose group were significantly lower than those in low-dose group(P<0.05).The effective rates of children in low,medium and high-dose group were 73.08%,88.46% and 92.30% respectively.There was no significant difference between the three groups(P>0.05).The levels of serum NO and PCO_2 and SaO_2 increased significantly(P<0.05),and PCO_2 and ET-1 decreased(P<0.05).The increase or decrease of each index in middle and high dose group was significantly greater than that in low dose group(P<0.05).There was no significant difference in the changes of arterial blood pressure and the incidence of adverse reactions among the three groups(P>0.05).Conclusion Sildenafil is effective in the treatment of PPHN with less adverse reactions.The concentration of sildenafil is 1.0 and 1.5 mg/kg.
引文
[1] 李宁,陈红武,张俊亮,等.新生儿持续肺动脉高压的危险因素分析[J].中华实用儿科临床杂志,2017,32(9):687-690
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[6] Iijima S,Ueno D,Baba T,et al.Hypertrophic pyloric stenosis following persistent pulmonary hypertension of the newborn:a case report and literature review[J].Bmc Pediatrics,2018,18(1):290-291
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[8] Sayed A,Bisheer N.Outcome of oral sildenafil in neonatal persistent pulmonary hypertension of non-cardiac causes[J].Journal of neonatal-perinatal medicine,2015,8(3):116-118
[9] 黄石安,罗鹏,吴源聪,等.GTP结合蛋白α亚基11在肺动脉高压大鼠肺无肌动脉肌化过程中的表达及西地那非的干预作用[J].中华医学杂志,2016,96(22):1762-1765
[10] Committee J F.British National Formulary (BNF) 70[M]// British national formulary.British Medical Association and Royal Pharmceutical Society of Great Britain,2008:580
[11] 中华医学会儿科学分会新生儿学组.新生儿肺动脉高压诊治专家共识[J].中华儿科杂志,2017,55(3):163-168
[12] 陈萍,王宁玲.西地那非在新生儿持续性肺动脉高压中的应用效果及安全性分析[J].重庆医学,2017,46(13):1820-1823
[13] 陈玲,张炼,李文斌.不同剂量西地那非治疗新生儿肺动脉高压的疗效[J].华中科技大学学报(医学版),2012,41(2):210-213
[2] 燕超,李振光.吸入不同浓度一氧化氮治疗新生儿持续性肺动脉高压的疗效及安全性分析[J].中国妇幼保健,2018,5(4):15-17
[3] 赵赛,程怀平,田兆方.枸橼酸西地那非片联合多巴胺治疗对新生儿持续肺动脉高压血清炎性因子水平的影响[J].儿科药学杂志,2015,5(8):14-17
[4] 安艳斌,王红云.西地那非与联合酚妥拉明对新生儿持续性肺动脉高压治疗观察[J].中国妇幼健康研究,2016,6(s2):118-120
[5] 中华医学会儿科学分会新生儿学组.新生儿持续肺动脉高压诊疗常规(草案)[J].中华围产医学杂志,2003,6(1):61-62
[6] Iijima S,Ueno D,Baba T,et al.Hypertrophic pyloric stenosis following persistent pulmonary hypertension of the newborn:a case report and literature review[J].Bmc Pediatrics,2018,18(1):290-291
[7] 王林啸,肖玥玥,段永丽,等.磷酸二酯酶5抑制剂的研究进展[J].中国药物化学杂志,2017,5(5):400-407
[8] Sayed A,Bisheer N.Outcome of oral sildenafil in neonatal persistent pulmonary hypertension of non-cardiac causes[J].Journal of neonatal-perinatal medicine,2015,8(3):116-118
[9] 黄石安,罗鹏,吴源聪,等.GTP结合蛋白α亚基11在肺动脉高压大鼠肺无肌动脉肌化过程中的表达及西地那非的干预作用[J].中华医学杂志,2016,96(22):1762-1765
[10] Committee J F.British National Formulary (BNF) 70[M]// British national formulary.British Medical Association and Royal Pharmceutical Society of Great Britain,2008:580
[11] 中华医学会儿科学分会新生儿学组.新生儿肺动脉高压诊治专家共识[J].中华儿科杂志,2017,55(3):163-168
[12] 陈萍,王宁玲.西地那非在新生儿持续性肺动脉高压中的应用效果及安全性分析[J].重庆医学,2017,46(13):1820-1823
[13] 陈玲,张炼,李文斌.不同剂量西地那非治疗新生儿肺动脉高压的疗效[J].华中科技大学学报(医学版),2012,41(2):210-213